Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes

Abstract

Intersphincteric resection (ISR) is the ultimate anus-sparing technique for low rectal cancer and is considered an oncologically safe alternative to abdominoperineal resection. The application of the robotic approach to ISR (RISR) has been described by few specialized surgical teams with several differences regarding approach and technique. This review aims to discuss the technical aspects of RISR by evaluating point by point each surgical controversy. Moreover, a systematic review was performed to report the perioperative, oncological, and functional outcomes of RISR. Postoperative morbidities after RISR are acceptable. RISR allows adequate surgical margins and adequate oncological outcomes. RISR may result in severe bowel and genitourinary dysfunction affecting the quality of life in a portion of patients.

Keywords: Intersphincteric resection; Low rectal cancer; Robotic surgical procedures; Surgical technique.

Fig. 1.

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) study [21] flow diagram.

Fig. 2.

Trocar positioning for the da Vinci Si (A), Xi (B), and Single-Port (SP) as described by Toh and Kim [45] and Cheong et al. [46]. MCL, midclavicular line. Yellow circle, da Vinci 12-mm port; red circle, 12-mm standard port; blue circle, da Vinci 8-mm port; green circle, 5-mm standard port (assistant); white circle, 25-mm access for SP placement.